Applying estimated glomerular filtration rate to an ageing population: are we in danger of becoming ageist?

Abstract

BACKGROUND: Management of CKD is a major public health concern. The introduction of automated eGFR reporting has seen an increase in labelling of elderly patients with CKD. The prognostic significance of the CKD label in this population remains controversial. AIM: To investigate rates of specialist intervention in the over 75's to determine whether these patients may be more appropriately managed in primary care, relieving the burden of excessive outpatient visits in this population. METHODS: Retrospective review of patient notes and laboratory reports over 25 consecutive renal outpatient clinics within a single NHS trust. RESULTS: 546 patients were studied. The mean age of patient was 68.7 years (SD+/-14.9). The over 75's had more advanced renal disease compared to under 75's (mean eGFR 28.2 vs. 41.3 ml/min/1.73 m(2)), but there was no significant difference in eGFR stability between the older and younger cohort or in the overall rate of intervention (32.5% vs. 30.7% p=0.86). The over 75's had a lower mean haemoglobin (11.8 vs. 12.6, p=<0.001) necessitating greater EPO requirements (25.2% vs. 10.5%, p=<0.001). The greatest intervention was seen in the more advanced CKD patients (29% of CKD 3 vs. 55% of CKD 5), and in those with diagnoses requiring immunosuppression. CONCLUSION: Intervention to management may be predictable on the basis of specific diagnoses and advancing CKD stage but not by patient age. We can provide no evidence to suggest that elderly CKD patients are managed any differently to younger patients and in fact have a higher need for attention to and treatment of renal anaemia, validating their attendance in nephrology clinic.